Provider Demographics
NPI:1215979448
Name:SORGEN, STEPHEN D (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:SORGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1957 ANTILLEY RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5208
Practice Address - Country:US
Practice Address - Phone:325-692-0188
Practice Address - Fax:325-698-4250
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE81812085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134339408Medicaid
TX134339409Medicaid
TX8R1555OtherBLUE CROSS OF TEXAS
TX134339408Medicaid
TX920003191Medicare PIN
TX87872KMedicare PIN
TX8R1555OtherBLUE CROSS OF TEXAS
TXTXB112946Medicare PIN
TX8R1555OtherBLUE CROSS OF TEXAS